Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea

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Rationale: Recent studies suggest that obstructive sleep apnea (OSA) severity can vary markedly from night to night, which may have important implications for diagnosis and management. Objectives: This study aimed to assess OSA prevalence from multinight in-home recordings and the impact of night-to-night variability in OSA severity on diagnostic classification in a large, global, nonrandomly selected community sample from a consumer database of people that purchased a novel, validated, under-mattress sleep analyzer. Methods: A total of 67,278 individuals aged between 18 and 90 years underwent in-home nightly monitoring over an average of approximately 170 nights per participant between July 2020 and March 2021. OSA was defined as a nightly mean apnea–hypopnea index (AHI) of more than 15 events/h. Outcomes were multinight global prevalence and likelihood of OSA misclassification from a single night’s AHI value. Measurements and Main Results: More than 11.6 million nights of data were collected and analyzed. OSA global prevalence was 22.6% (95% confidence interval, 20.9–24.3%). The likelihood of misdiagnosis in people with OSA based on a single night ranged between approximately 20% and 50%. Misdiagnosis error rates decreased with increased monitoring nights (e.g., 1-night F1-score = 0.77 vs. 0.94 for 14 nights) and remained stable after 14 nights of monitoring. Conclusions: Multinight in-home monitoring using novel, noninvasive under-mattress sensor technology indicates a global prevalence of moderate to severe OSA of approximately 20%, and that approximately 20% of people diagnosed with a single-night study may be misclassified. These findings highlight the need to consider night-to-night variation in OSA diagnosis and management.

Original languageEnglish
Pages (from-to)563-569
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Issue number5
Publication statusPublished - 1 Mar 2022

Bibliographical note

Funding Information:
Supported by a University of New South Wales Scientia Ph.D. scholarship (A.A.); National Health and Medical Research Council of Australia, a senior research fellowship (1116942) and an investigator grant (1196261) (D.J.E.); and the Nick Antic Sleep Research Scholarship from Flinders Foundation (B.L.). This was an investigator-initiated research study. Withings, the manufacturer of the under-mattress sensor technology used in this study, provided devices for validation in the study and deidentified data for analysis. Withings had no role in the study design, data analysis, data interpretation, or preparation of the manuscript.

Publisher Copyright:
Copyright © 2022 by the American Thoracic Society.


  • Misdiagnosis
  • Polysomnography
  • Sleep-disordered breathing
  • Wearables


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